Detecting deviations in clinical care in ICU data streams

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DESCRIPTION (provided by applicant): Timely detection of severe patient conditions or concerning events and their mitigation remains an important problem in clinical practice. This is especially true in the critically ill patient [1]. Typical computer-based detection methods developed for this purpose rely on the use of clinical knowledge, such as expert-derived rules, that are incorporated into monitoring and alerting systems. However, it is often time-consuming, costly, and difficult to extract and implement such knowledge in existing monitoring systems. The research work in this proposal offers computational, rather than expert-based, solutions that build alert systems from data stored in patient data repositories, such as electronic medical records. Briefly, our approach uses advanced machine learning algorithms to identify unusual clinical management patterns in individual patients, relative to patterns associated with comparable patients, and raises an alert signaling this discrepancy. Our preliminary studies provide support that such deviations often indicate clinically important events for which it is worthwhile to raise an alert. We propose an evaluation based on physician assessment of alerts that are generated from a retrospective set of intensive-care unit (ICU) patient cases. The project investigators comprise a multidisciplinary team with expertise in critical care medicine, computer science, biomedical informatics, statistical machine learning, knowledge based systems, and clinical data repositories. PUBLIC HEALTH RELEVANCE: There remain numerous opportunities to reduce medical errors in critical care by sending computer-based reminders and alerts to clinicians. This project uses past patient data, which is stored in electronic form, and machine-learning methods to help develop and refine computer-based alerts to improve healthcare quality and reduce costs.